Steatosis present in most adults with type 1 diabetes and overweight or obesity
Click Here to Manage Email Alerts
Key takeaways:
- Of adults with type 1 diabetes, 100% with obesity and 64.9% with overweight had a positive hepatic steatosis index score.
- Liver disease screening should be integrated into routine diabetes care.
Hepatic steatosis may be present in most adults with type 1 diabetes, especially those with overweight or obesity, according to a study published in Journal of Diabetes and Its Complications.
“Most patients with type 1 diabetes have nonalcoholic fatty liver disease (NAFLD) steatosis by liver scores, yet very few have had any investigation for this condition,” Michelle D. Lundholm, MD, a clinical endocrinology fellow at Cleveland Clinic, told Healio. “It is alarming how under-investigated and underdiagnosed NAFLD is in the population with type 1 diabetes. We are missing opportunities to detect early NAFLD disease and apply cardiometabolic interventions to prevent irreversible liver damage.”
Lundholm and colleagues conducted a retrospective cross-sectional study of 447 adults with type 1 diabetes who attended a visit at the Cleveland Clinic endocrinology clinic between 2015 and 2018 (mean age, 38.6 years; 54% women; 82% white). Demographics, laboratory data, liver imaging, liver biopsy and hepatology referrals were obtained from electronic medical records. The hepatic steatosis index and Framingham steatosis index were used as markers for steatosis, whereas FIB-4 and aspartate transaminase to platelet ratio index served as fibrosis markers.
Most participants had a score indicating possible steatosis; 60.6% had a positive hepatic steatosis index score, 32.9% had an indeterminate score and 6.5% had a negative score. When Framingham steatosis index was used, 51.5% of the cohort had a positive score and 48.5% had a negative score. When adults were divided into categories based on BMI, all participants with obesity, 64.9% of those with overweight and 22.3% of adults with normal weight had a positive hepatic steatosis index score (P < .001). Similar findings were observed when Framingham steatosis index was used.
Of 221 adults who were older than 35 years and able to have FIB-4 calculated, 3.6% had a high score and 21.3% had an indeterminate score. FIB-4 score was low for 75.1% of participants. When aspartate transaminase to platelet ratio index was used, 2.5% had severe fibrosis and 1.6% had significant fibrosis. There were no differences in participants with high scores for fibrosis using either marker when adults were divided into BMI categories.
Women, older age, higher BMI, low HDL cholesterol, and the presence of hypertension, hyperlipidemia and metabolic syndrome were all predictors for a positive hepatic steatosis index score. Predictors for a positive Framingham steatosis index score included older age, higher BMI, higher triglycerides, lower HDL cholesterol, higher triglyceride to HDL ratio, and the presence of hypertension, hyperlipidemia, cardiovascular disease and metabolic syndrome. Older age was the only predictor for a high or indeterminate FIB-4 score, and there were no predictors for a severe or significant fibrosis score using aspartate transaminase to platelet ratio index.
Between 2015 and 2021, 21% of the cohort had some form of abdominal imaging performed. Of the subgroup, 21.3% had hepatic steatosis noted, which was typically an incidental finding, according to the researchers. Of the full cohort, 1.8% were referred to a hepatologist and 1.3% underwent a liver biopsy.
Lundholm said NAFLD screening needs to be integrated into routine diabetes care to better detect and treat the disease at early stages.
“Liver function tests are often falsely reassuring, as over 75% of patients with NAFLD steatosis by liver scores had normal transaminases,” Lundholm said. “Therefore, liver scores are the first screening step, to be followed by liver imaging, liver biopsy and hepatology referral, as indicated.
Researcher Sangeeta R. Kashyap, MD, assistant chief of clinical affairs in the division of endocrinology, diabetes and metabolism at Weill Cornell Medicine New York Presbyterian, and a Healio | Endocrine Today Co-Editor, said more studies are needed to investigate liver imaging in adults with type 1 diabetes and intermediate- or high-risk liver scores.
“Liver steatosis is common in type 1 diabetes, and nonalcoholic steatohepatitis (NASH) is underdiagnosed,” Kashyap told Healio. “Weight loss and possibly use of GLP-1 agonists may reduce risk for NAFLD and NASH in this population. Current use of these strategies are underutilized in adults with type 1 diabetes.”
For more information:
Sangeeta R. Kashyap, MD, can be reached at srk4008@med.cornell.edu.
Michelle D. Lundholm, MD, can be reached at lundhom@ccf.org.
Collapse
Click Here to Manage Email Alerts